Intra abdominal HTN...compartment syndrome

Intra-abdominal hypertension (defined as a sustained urinary bladder pressure > 12 mm Hg) may be an under-recognized problem in the ICU, especially in patients after abdominal surgery or who have gone massive volume resuscitation with blood and/or fluids (think hemorrhage, burns and sepsis). When high abdominal pressures (> 20 mm Hg sustained) cause organ failure and/or shock, it’s calledabdominal compartment syndrome.

Below are the strategies to cope with this complication..

• improving abdominal wall compliance through sedation, analgesia, and pharmacologic paralysis;
• evacuating intraluminal contents through nasogastric and rectal decompression;
• correcting positive fluid balance through the use of hypertonic fluids, colloids, and careful diuresis;
• supporting organ function with vasopressors and judicious goal-directed fluid resuscitation to maintain an abdominal perfusion pressure (APP) ≥ 60 mm Hg (calculated as mean arterial pressure − IAP); and
• early surgical intervention when IAP exceeds 25 mm Hg and progressive organ dysfunction is present.